Provider Demographics
NPI:1043247547
Name:KENNEY, PHILIP (MD)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:
Last Name:KENNEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4301 W MARKHAM ST # 556
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-7101
Mailing Address - Country:US
Mailing Address - Phone:501-686-8000
Mailing Address - Fax:
Practice Address - Street 1:4301 W MARKHAM ST # 556
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-7101
Practice Address - Country:US
Practice Address - Phone:501-686-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2008-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL125212085R0202X
ARE-56532085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000015482Medicaid
MS00117079OtherMISSISSIPPI MEDICAID
AL051505919OtherBLUE CROSS
AL051534428OtherBLUE CROSS
AL000015482OtherBLUE CROSS
AL009909405Medicaid
AL051512215OtherBLUE CROSS
AR169640001Medicaid
AL051505919Medicaid
ALC76169OtherVIVA
AL009937203Medicaid
AL010033CC76169OtherSECTION 1011
AL051511500OtherBLUE CROSS
AL300059301OtherRAILROAD MEDICARE
AL051511500OtherBLUE CROSS
MS00117079OtherMISSISSIPPI MEDICAID
AL000015482Medicaid